Depression, bipolar disorder the focus of new research at UBC

Five per cent of Metro Vancouver residents suffer from one or the other

Dr. Raymond Lam says depression is the top mental illness in terms of burden, accounting for more than the burden of lung, colon, breast and prostate cancers combined.

Photograph by: Jason Payne
, VANCOUVER SUN

Chances are high that most people reading this have either been affected by a mental illness, or know someone who has.

“When you examine the statistics for illnesses, mental illness easily beats every other in terms of burden,” said Dr. Raymond Lam, a professor of psychiatry and medical director of the Mood Disorder Centre of Excellence at UBC Hospital.

The two most common mental illnesses are depression and bipolar disorder and at any given time at least five per cent of the population of Metro Vancouver will suffer from one or the other — that’s 50,000 people with a severe enough mental illness to put them in the hands of a physician.

That mental illness is so prevalent is not news to those who have to treat it.

An Ontario study released last year showing the burden mental illness places upon society to be many times that of physical illnesses, such as cancers and heart disease, is mere confirmation of an accept ed truth.

“The results of the study are no surprise because we’ve been saying this for years,” Lam said.

“We measure burden different ways. One of the terms we use is health adjusted life years. That is a combination of years lost from early mortality – so if you die too young – and years lived with a disability when you are not able to function in the same way.

“Economists can collapse those things together to form a metric to compare different conditions and so the Ontario study found the burden of mental illnesses was 1.5 times as great as all cancers and more than seven times greater than all infectious diseases, excluding HIV,” said Lam.

“So if we are talking about depression, which is the top mental illness in terms of burden, then depression accounts for more than the burden of lung, colon, breast and prostate cancers combined,” he said.

Despite this, the amount of research funding given mental illness is only a small fraction of that assigned to finding cures for cancers.

“That’s one of the problems — mental illness is still not seen to be as important as some of those other conditions,” he said.

Lam said it was significant that mental illness does not have a national philanthropic organization dedicated to raising money for research, such as the Heart and Stroke Foundation.

He put that down to the stigma generally associated with mental illness.

“It’s better than it was but there’s definitely a stigma associated with having something like a mood disorder. It interferes with people seeking help and unfortunately extends to services available to people and the research dollars, which are really a drop in the bucket compared to what is spent on other diseases,” he said.

However, the Mood Disorder Centre has a national and international reputation for its research programs and Lam, as the director of the centre, is on the executive committee of a new national organization, Canbind — the Canadian Biomarker Integration Network for Depression.

Canbind researchers will be hunting for biomarkers that will help predict the likelihood that a patient will respond to the various medications and therapies used to treat depression.

The five-year study will commence later this year and is being led by Dr. Sidney Kennedy, a professor of psychiatry at the University of Toronto.

“We’ve had ethics approval and we’re ready to go,” said Lam.

“Identifying biomarkers for disease and treatment is the biggest area in medicine right now. We’re a little behind in psychiatry because we don’t have a clear brain pathology. We know there are changes in the brain when people have various psychiatric conditions but we don’t know exactly what they are.

“We’re often shooting in the dark because we can’t predict who is going to respond to a particular treatment — whether it’s medication, neuro-stimulation or psychotherapy, we just don’t know.

“We know 60 per cent of people respond to treatment but which 60 per cent for any particular treatment?”

Lam said the research will concentrate on persons suffering from major depression.

“We’re going to carefully characterize them and learn a lot about their symptoms — physical and emotional — and their backgrounds, which will include things like life stresses, childhood traumas or adversities, and family histories.

“We’ll characterize their clinical information and we’ll also be getting brain imaging from them,” he said.

Blood and saliva samples will be taken and analyzed and genetic information recorded.

“We’re going to look at blood-based biomarkers, genetic markers, or other things in the blood we can measure, like inflammatory proteins, which we think are associated with depression,” he said.

“Then we will treat them with anti-depressant medication and restudy them after two weeks to see what changes have occurred in the brain to see if any of those changes will predict whether someone will ultimately respond after several weeks of treatment to those medications,” said Lam.

He said researchers across the country will be gathering huge amounts of information from persons suffering from depression and will be using new computer techniques to find, they hope, the answers they are seeking.

“We are hoping to be able to tease out a subgroup, a certain type of person who might respond. For instance, someone who has had a stress might respond differently to the medication than someone who hasn’t had stress,” he said.

“There’s lots of interesting work being done right now in childhood adversity — people who have had a childhood trauma, whether it was physical or sexual abuse. We now know that (abuse) produces changes in the brain that last to adulthood, so those people may respond differently to the same treatment given those who look like they have the same kind of depression but haven’t had those brain changes.”

The Mood Disorder Centre is located close to UBC Hospital and provides inpatient and outpatient care. Some 2,500 persons are treated there each year — the vast majority as outpatients.

Dr. Heather Robertson runs the 15-bed inpatient unit in the centre, which treats persons with severe mood disorders requiring admittance to hospital for a number of weeks and specialized treatment.

Many patients are admitted who have a high potential for self-harm or who have attempted suicide or are found to be out of touch with reality.

“Major depression is obviously a debilitating illness which is associated with several other symptoms — losing interest in things, lack of energy, concentration, sleep alteration, change in appetite and diminished self-esteem, self-worth, feelings of guilt that you are a burden on your love ones,” Robertson said.

“It can make it very difficult for you to get through your everyday tasks and it can really impact your ability to work and leave you socially isolated. It’s a silent illness and people often have difficulty reaching out for help,” she said.

“Bipolar has both highs and lows. Persons suffering from that have … depression then their mood changes to mania, the opposite of depression. They can be euphoric or irritable, they tend to be more energized, their thoughts tend to go faster and they have an increase in self-esteem. They are more driven and their judgment and insight and risk-taking behaviour changes, and they can become very grandiose and overestimate their abilities to the point where they lose touch with reality,” Robertson said.

“Some people rapidly cycle between these two states and they can be difficult to treat.”

Treatment in the hospital ranges from psychological counselling to medication or, for those not responding to medication or unable to tolerate it, electro-convulsive therapy, which delivers an electric shock to the brain.

“This releases a flood of neuro-transmitters and provokes a seizure in the brain that helps reset the balance and helps the medication do its job. It’s not the first-line treatment, obviously, because you have to undergo an anesthetic, but it is the most effective,” she said.

(There is also a newer treatment being used in Vancouver General Hospital, transcranial magnetic stimulation or TMS, which uses magnetic pulses to the same effect but doesn’t require anesthetic.)

“Early intervention is the key. We know if you limit the number of episodes it helps in treatment. So education is important. People need to understand the illness and the ways to treat it, and the ways to prevent another episode or spot the early warning signs,” she said.

“For a lot of people they take their medication, have follow up and are absolutely fine.”

It is important to realize that depression and bipolar disorder are common and “very treatable,” Robertson said.

“For us the silver lining in all this is that we get to see the positive side. We know there is going to be a light at the end of the tunnel and in that way we are able to provide hope for people.”

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